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Summary for Airway Obstruction ,Pharynx and Larynx Disease Presentation Findings Dx. Rx. Laryngomalacia ○ Intermittent inspiratory Laryngeal finding: ○ HX ○ Observation (most of the stridor that improve in ○ Inward collapse of short ○ flexible fiberoptic time the condition will Most common cause of prone position, Worse with aryepiglottic fold and endoscopy improve) stridor in neonate and crying, feeding and RTI. epiglottis into laryngeal inlet ○ it can’t be diagnosed in ○ Supraglottoplasty (signs infants, 2nd is Bilateral ○ Snoring. during inspiration the OR when the patient is of growth retardation, signs of vocal cord paralysis and 3rd ○ Omega shaped epiglottis sedated airway obstruction like: subglottic stenosis peak at 2-4 months, cyanosis, sleep apnea, and subside at 12-18 months desaturation). ○ Tracheostomy (last resort) Subglottic stenosis ○ Biphasic stridor ● Grades (Cotton-Myer ○ Chest and neck X-ray Grade 1-2 Incomplete recanalization, ○ Failure to thrive. grading system): ○ flexible endoscope Observation small cricoid ring (<4mm) ○ Recurrent croup. I: < 50% ○ Bronchoscopy Endoscope (CO2 laser ● Dyspnea II: 50% - 70% ○Video- excision or balloon dilation) Cause: prolonged ● Hoarseness III: 70%- 99% strobolaryngoscopy Grade 3-4 intubation (> 2 weeks) is ● Brassy Cough IV: undetectable lumen. - Tracheostomy. more common than ● Recurrent pneumonitis - LTR (Laryngotracheal congenital. ● Cyanosis reconstruction) - CTR (Cricotracheal Resection). (Ant cricoid split) Laryngeal web (vocal ○ Weak cry at birth ○ Flexible endoscope ○ Observation cord web) ○ Dysphonia ○ Laser excision ● Incomplete canalization. ○ Variable degrees of ○ Open procedure (flap and respiratory obstruction steroid injection) ○ On and off stridor ○ tracheostomy (Posterior laryngeal web) Subglottic hemangioma ○ Biphasic stridor ○ Flexible endoscope ○ Observation (Capillary type ● The most common ● 50% associated with typically resolve) congenital pediatric tumor, cutaneous involvement. ○ Intralesional steroid (old). and it is most common in ○ Propranolol subglottic space. ○ CO2 Laser ablation. Traumatic Conditions of ● Inhalation ➜ sloughing Granuloma, Common with ○ Medical Hx. ○ Intubation (thermal injury) the Larynx: and carbonized tissue intubation or reflux (on the ○ Radiography ○ steroids ● Acute episode of Foreign posterior third of the vocal ○ Bronchoscopy (Dx and ○ antibiotics blows, Penetration, Burns, Body Aspiration: choking, fold) most commonly Rx of FB aspiration) ○ Anti-Reflux Drugs Inhalation foreign bodies, gagging, wheezing, or unilateral: necreosis. ○ Voice rest (granuloma Intubations injuries. hoarseness. bilateral: adhesions. Usually isn’t removed due to ●Abrasion (injury to the high recurrence) mucosa) ➜ granulomatous ○ Endoscopic removal. formation ➜ subglottic ○ Lifestyle modifications stenosis. Vocal cord paralysis ○ Inspiratory stridor Bilateral Vocal Cords MRI of the brain to check ▪ Tracheostomy in severe (bilateral) Paralysis “Abducted type” for Arnold Chiari cases. ▪ Spontaneous Congenital ○ Dysphonia (unilateral) – Malformation (congenital recovery. Acquired: forceps delivery, breathy voice. VC paralysis) ▪ Surgical intervention cardiac surgery “Patent ○ Choking in recurrent postponed until the patient ductus arteriosus repair”, laryngeal nerve injury. become old: mediastinal or neck surgery, ○ Lateralization (stridor): tracheo-esophageal fistula Arytenoidectomy and laser repair. cordotomy. ○ Medialization (dysphonia): VC injections Acute Laryngitis ● Dysphonia ● Rhinovirus ● Conservative (glottic) ● Fever ● Parainfluenza ● steroids ● Barking cough due vocal cord edema. Acute Epiglottitis ● Dysphonia (HOT Haemophilus influenza B ● Direct visualization using ● Intubate in the OR. (supraglottic) POTATO) (2-6 year). (rare nowadays laryngoscopy after ● IV Antibiotics. ● Fever due to vaccinations). stabilizing the patient. ● steroids ● No cough ● Lateral neck soft-tissue ● Drooling x-ray (epiglottic swelling: ● Dyspnea / stridor Thumbprint sign, vallecula ● Sniffing position sign) ● Dysphagia ● Sore throat Croup (Laryngo- ● Hoarseness Parainfluenza (1-5 years) ● clinical diagnosis ● Humidified O2. tracheobronchitis) ● Biphasic stridor ● X-ray (subglottic ● Nebulized Racmic (subglottic) ● Fever narrowing: Steeple sign) Epinephrine ● Brassy cough (Barking) ● Steroids ● No Dysphagia Diphtheric Pharyngitis ● Sore throat. ● Corynebacterium ● Greyish –white friable ● Antitoxin injection. and Laryngitis ● Dysphonia. diphtheriae (rare nowadays membrane. ● Systemic penicillin. ● Cough. due to vaccinations) ➔Culture ● Oxygen. ● Stridor (suggests the ● Tracheostomy. spread of the membrane to Complications: the larynx and trachea), ● Myocarditis. ● Fever. ● Nephritis. ● Airway obstruction Moniliasis - Fungal ● Dysphonia. ● Candidiasis, aspergillosis Antifungal (nystatin) Laryngitis ● Cough. (Immunocompromised). ● Odynophagia. Recurrent Respiratory ● Hoarseness ● HPV 6-11 (common). Laryngoscopy or ○ Recurrent laser excision, Papillomatosis (IMP) ● Stridor ● HPV 16-18 (malignancy) - bronchoscopy. micro debridement. Two types: juvenile and ● Choking episodes. rare. Microlaryngoscopy polyp senile. ● Foreign body sensation in Risks: Young first time excision. ● 2/3 before age 15 the throat. mother, condyloma ○ Adjunctive therapy: (juvenile). “very ● Cough. acuminata Cidofovir, acyclovir, interfero, aggressive”. ● Dyspnea. new treatment: Avastin. ● Inspiratory wheeze. Malignant Neoplasm Of Hoarseness, Supraglottic (30-40%, Risks: Smoking, alcohol, depend on stage (TNM) The Larynx (squamous aspiration, dysphagia, Nodal metastasis). radiation exposure. ○ Radiotherapy. cell carcinoma of VC). stridor, weight lost. Glottic (50-75%, Limited ○ Hemilaryngectomy. regional metastasis). ○ Total Laryngectomy + Neck Subglottic (Rare, 20% dissection regional metastasis). (lymphadenectomy). Nasal Obstruction (cystic cyanosis improves with CT or MRI to check or solid mass) crying and worsens on extension of feeding (cyclic cyanosis) meningoencephalocele Choanal Atresia Bilateral: (cyclic cyanosis) CT to differentiate ▪ Emergency treatment is by Unilateral: may be between the types insertion of oral tube undiagnosed until later in (Membranous 10%, Bony, ▪ Surgical treatment is by childhood (rhinorrhea) Mixed) either transnasal or CHARGE Syndrome transpalatal choanal atresia repair Peritonsillar abscess ● Fever ▪ Clinical diagnosis. ● I&D (quinsy) ● severe sore throat ▪ CT scan. ● Aspiration ● Otalgia Complications ● IV ABX ● Odynophagia ➢Para and ● Tonsillectomy (after 6 ● Uvular deviation retropharyngeal abscess weeks) ● Trismus ➢ Aspiration pneumonia ● Drooling ● Hot potato voice Retropharyngeal ● Odynophagia Complications ● TRANSORAL Drainage abscess ● Hot potato voice ➢Mediastinitis ● IV ABX ● Drooling ➢Respiratory distress ● Airway management ● Stiff neck ➢Rupture abscess ● Fever ● Stridor ● cervical adenopathy Parapharyngeal ● Trismus Complications ➢Aspiration ● Laboratory and ● EXTERNAL drainage abscess ● fever ➢Cranial nerve palsy bacteriology ● IV ABX ● Neck mass ● CT (best modality) ● Airway management ➢Airway compromise ● muffled voices (hot potato ● MRI voice) ➢Septic thrombophlebitis ● intraoral bulge ➢Carotid blowout ➢Endocarditis Adenoid hypertrophy ● Mouth breathing and ➢ Grade 1: <25% ● Lateral x ray shows ➔ Conservative if small. (3-7 years) snoring. ➢ Grade 2: 25-50% enlarged adenoid (IMP) ➔ Surgical: adenoidectomy. ● Hyponasality ● Flexible fiberoptic. (now ➢ Grade 3: 50-75% Indications: ● Adenoid face (long and used instead of x-ray) recurrent / persistent OM, open-mouthed face). ➢ Grade 4 : 75-100% (complete obstruction) recurrent/chronic sinusitis, ● Nasal discharge obstructive sleep apnea. ● Eustachian tube obstruction > ON. Acute tonsillitis ● Fever. CAUSES ● Viral (most Complications ● Oral antibiotics (penicillin), ● Sore throat. common cause). ● Bacterial ● Peritonsillar abscess bed rest, hydration, ● odynophagia. (group A β-hemolytic (Quinsy). analgesia. ● Jaw stiffness (trismus). streptococcus) moraxella, ● Parapharyngeal or ● If the symptoms are severe ● Halitosis (bad breath). H. influenza, bacteroides). retropharyngeal abscess. : admit the patient and give ● Otitis media. IV fluids, IV antibiotics and Phases: erythema, ● Rheumatic fever, analgesia. exudative, follicular glomerulonephritis, scarlet indications for tonsillectomy tonsillitis. fever. = associated with 1) Recurrent, 6 attacks in 1 group A streptococcus year OR 4 times per year in 2 (GAS). years OR 3 times per year in 3 years. 2) Grade 3 or 4 tonsils → (OSA) 3) Asymmetrical tonsillar enlargement + smoker > biopsy 4) Peritonsillar abscess. INFECTIOUS ● Fever. Pathogen: Epstein barr ➔Monospot test. ➔Paul ● Hydration, analgesia and MONONUCLEOSIS ● Lymphadenopathy. virus. bunnel test (heterophile oral hygiene. ● Malaise. Adolescents are especially antibodies in serum) 80% ● avoid ampicillin, as it ● Exudative tonsillitis. susceptible (kissing mononuclear and 10% causes maculopapular rash. ● Hepatosplenomegaly. disease). atypical lymphocytes on Complications ● Membrane on tonsils smear. ● Involvement of cranial (membranous tonsillitis) nerves. ● Meningitis. ● Autoimmune hemolytic anemia. ● Splenic rupture (restrict activity). Scarlet fever ● Red pharynx The rash of scarlet fever is Dick test: a test to Antibiotic (Scarlatina) ● Strawberry tongue caused by the streptococcal determine susceptibility or ● Perioral skin erythema pyrogenic exotoxins (ie, immunity to scarlet fever and desquamation SPE A, B, C, and F). by an injection of scarlet ● Dysphagia fever toxin. ● Malaise ● Severe cervical lymphadenopathy. Vincent’s
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